to one of three groups: expectant management (no specific intervention)

• surgical management (curettage under general anaesthesia)
  
  
• medical management (vaginal dose of misoprostol (for those with early fetal loss oral mifepristone was given one to two days carlier).

All women were given an information sheet and emergency telephone number, and had a full blood count performed. All Rhesus negative women were offered 250 IU of anti-D. Ten to 14 days later, the women were followed up with a trans-vaginal ultrasound, full blood count, consultation with the study nurse and gynecologist examination, if symptoms of infection were present.

At follow up, the rate of infection was 2 to 3% in all three groups. Similarly, the time taken to return to normal activities and rates of anxiety and depression did not differ between the groups. Hemoglobin levels were also comparable, but 2 and 1% of women in the expectant and medical treatment groups, respectively, received a blood transfusion. The rate of surgical complications (mainly uterine perforation) was 2%.

Overall 44, 89, and 36% of women in the expectant, surgical and medical management groups underwent curettage.

Authors of an accompanying editorial said the high rate of curettage following medical management occurred because, in line with the protocols of the time, women were assessed eight hours after misoprostol administration and curettage was offered if expulsion had not begun (BMJ 2006; 332:1223-1224). Current practices would delay assessment after administering misoprostol for at least seven days, they noted.

The editorialists said that women should be offered a choice for managing first trimester miscarriage. `Does she wish to have surgical evacuation that will provide a rapid resolution to the problem but has a 1:50 complication rate, or expectant management which - although unpredictable - will probably allow her to avoid admission to hospital. Medical management should speed up her miscarriage and reduce the likelihood of her having surgical intervention to around 5 to 15%', they said.

Reference: Adopted from Medicine Today, July 2006